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Chances are you’ve heard the gluten-free hype. Going gluten free has been touted as the next big weight loss wonder, and books and articles have bounced on the scene to wax eloquent on this newest health fad. Grocery stores and health food stores alike rose admirably to the occasion and upped their stock of products stamped ‘GF’. While there is a grain of truth (pardon the pun) that properly removing gluten from the diet can help aid in healthy weight loss, it’s time to discuss some of the conditions that actually necessitate going gluten free above and beyond a desire for a slimmer waistline.

If you are the average layperson, you may have heard of someone having celiac disease, an allergy to wheat or even just being sensitive to gluten. Gluten contains glutenins and gliadins, which are protein components of gluten and are the main offenders in conditions that necessitate going gluten free. While these conditions all require going gluten free, it’s important to understand the physiological components that make these different.

Wheat Allergy

An allergy to a food occurs when our immune systems recognize a food or food component (often a protein) as being foreign and attacks it, initiating an inflammatory response mediated by our IgE antibodies. It is estimated that 15 million Americans have some type of food allergy. For someone with an allergy to wheat, eating the offending food causes an immediate reaction. One might experience hives, swelling, or anaphylaxis if the allergy is severe. These kinds of reactions are those you might associate with peanut or shellfish allergies. So, if you have a wheat allergy, you’ll be inadvertently going gluten free for the most part. However, you can still eat barley and rye (which contain gluten) as long as they haven’t been processed with wheat. Avoid these grains if you have a wheat allergy: farro, spelt, kamut, bulgar, or semolina.

Celiac Disease

Celiac disease is an autoimmune disease characterized by inflammation and damage to the small intestine caused by the ingestion of gluten in any amount (found in wheat, barley and rye). It is estimated that more than 3 million Americans have celiac disease. Eating gluten causes the microvilli in the small intestine to flatten, causing inflammation, GI symptoms and malabsorption. Although there isn’t conclusive evidence on what causes Celiac, a genetic component has been discovered. Additionally, it has been linked to IBS, autism, psoriasis, lactose intolerance and depression. Commonly, celiac disease will cause GI pain, bloating, diarrhea, inability to gain weight and anemia. However, it can be difficult to diagnosis and may be advanced by the time it is recognized. For this reason, those with this condition may also have vitamin and mineral deficiencies and osteoporosis due to long term malabsorption. Celiac disease is diagnosed by a genetic test or by a blood test to identify the presence of gluten antibodies known as transglutaminase (tTG) antibodies. Wheat, barley and rye must all be avoided to regain the digestive capacity. Gluten free grains that are safe for consumption include amaranth, millet, teff, quinoa, brown rice, buckwheat and oats (as long as they have not been processed with wheat as they often are).

Non-Celiac Gluten Sensitivity

Non-Celiac Gluten Sensitivity (NCGS) embodies similar symptoms as does Celiac disease, however those with NCGS do not have the flattening of the microvilli in the small intestine or the malabsorption. It is estimated that nearly 18 million Americans are sensitive to gluten. They do not have the antibodies to gluten in their blood, but find that they feel much better when they don’t consume gluten. Gluten sensitivity may also be determined through an IgG antibody food sensitivity test. Those who are sensitive will do well on a gluten free diet. We don’t yet know what causes NCGS. It may be that these people have a lack of integrity in their small intestine lining, commonly caused leaky gut. They may have the genetic component seen in Celiac, or they may have some other underlying cause. Whatever the etiology, those with a sensitivity to gluten will thrive best when eating gluten free grains such as amaranth, millet, teff, quinoa, brown rice and buckwheat. Sometimes, those sensitive to gluten find they can tolerate it every couple of days in a rotation after they have removed it from their diet for at least a month.

What if I just want to try it?

Good news! You don’t have to have a diagnosis of one of the above to remove gluten from your diet. You may just want the benefits of a low carb diet (which will remove most gluten containing foods anyway), or a way to remove refined grains and sugars from your diet. And deciding to go gluten free can be a good remedy for that. A word of caution: Many packaged gluten free products use corn or potato starch and additives. Gluten free does not mean sugar or calorie free, so if you are buying lots of boxed or bagged gluten free products make sure you read the label. Many people start a gluten free diet to lose weight, but load up on other starchy and processed foods instead which can cause blood sugar dysregulation issues and weight gain. It’s always best to shop the perimeter of your grocery store (where the fresh foods without labels live) and be cutting and chopping up your own food in your kitchen!